Provider Demographics
NPI:1962979484
Name:PLASTIC AND RECONSTRUCTIVE CARE, LLC
Entity type:Organization
Organization Name:PLASTIC AND RECONSTRUCTIVE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROMAGNOLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-801-6741
Mailing Address - Street 1:3505 ALMA AVE
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-3330
Mailing Address - Country:US
Mailing Address - Phone:310-801-6741
Mailing Address - Fax:
Practice Address - Street 1:9735 WILSHIRE BLVD PH
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-2104
Practice Address - Country:US
Practice Address - Phone:310-860-8915
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LEIF L. ROGERS, MD,LLC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-11-02
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory SurgicalGroup - Single Specialty